HomeMy WebLinkAboutHYDRANT USE PERMIT 2 - 23-00331 - Edstroms construction FHM 7(. r
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FIRE HYDRANT USE PERMIT
NONT1tADMONAL WATER CUSTOMERS
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CitY Kate Zip:
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Hose Number:
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rear lssued: A5 Z.1
Deposit at, (Receipt Cade= credit cards charge an dional 3.5%(Receipt Code= M15CG;
SZ,500 - 2' Water Meter * DepOsit retained? V or refunded?
$ SW - 1' Water Meter (date)
C01VOrT10 Of PERMrr:
in order to prevent possible contamination from bacidlow of the Rexburg crty water system, any persor- = e^* -,
desiring to obtain water from a city fire hydrant must comply with the following:
L Obtain a written permit from Rexburg City Hall, 35 N 1" East, before attempting to take any water
Z Take water only from the one fire hydrant designated by the city water depanrnent
3. Check out the badffiow and metering device from the city water dept. to be attached to the fire hydrant
agreed upon by the user and the city water deptment.
4. As indicated above a deposit will be required on any metering device. Any damage to or loss of the dev►ct_
will be paid for by the user. After any use, repair, or replacement charges are deducted ,the balance of the
deposit will be refunded to the user. (City water dept. will conduct a final inspection.) / 1 kj
p
5 The fee for any water obtained through the metering device is as follows:
Fee, 1 —1,000 gallons $10.00 Each 1,000 gallons thereafter: $5.00 L/ /
6. A $50.00 maintenance fee for 1" and $75.00 maintenance fee for 2" will be assessed each year for
maintenance on the meter.
7 The meter needs to be returned by 1211 for testing calibrations. A meter can be reissued the same day per
request rf needed.
Any person or entity not complying with this policy shall be assessed a penalty charge of S400 in addition
to the normal charge for the water taken,
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. i nature of A Iicant
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REFUND TO,
METER OK: YES OUT READ
NO IN READ
GAL. USED
.59
yr0o -
CHARGES,
METER MAINT
0-1000 GAL 10,00
READ DATE _ ADDITIONAL WATER r
METER REISSUED? YES / NO REPAIRS -PARTS
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IHued by: Rmilved by. _ZL IF
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